Health & Medicine
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Richer countries are getting unfair access to life-saving vaccines
New research finds that the way vaccines are manufactured and priced is creating inequality between the world’s richest and poorest countries
Published 14 November 2024
The pneumococcal conjugate vaccine – known as PCV – prevents around 30 percent of pneumonia, the most common cause of childhood deaths worldwide.
But our new research has uncovered inequalities in how the net economic benefits of the vaccine are distributed around the world.
What we found was that any net economic benefits go mostly to pharmaceutical companies (in the form of profits) and high-income countries (if we look at prevented mortality and morbidity).
This is despite the fact that most of the world’s disease burden is concentrated in low and middle-income countries (LMICs).
Vaccines save lives and safeguard economies
Vaccines are often considered one of the most successful and cost-effective public health interventions.
In fact, childhood vaccines prevent two and a half million deaths each year from diseases like polio and measles, at less than a few dollars per dose – making them incredibly good value for money.
Over the last few decades, newer vaccines like rotavirus and PCV are protecting children from two of the leading causes of childhood mortality – diarrhoea and pneumonia.
PCVs have successfully reduced serious diseases like pneumococcal meningitis, sepsis and pneumonia in children.
But, the benefits of vaccines extend beyond their lifesaving abilities to their broader protective impact on health systems, economies and societies.
A healthy population is likely to have improved educational outcomes, live longer and contribute to better economic growth.
During the COVID-19 pandemic, vaccines meant nations like Australia, New Zealand and Pacific Island Countries, could reopen their economies and schools – preventing further economic and societal devastation.
Access to lifesaving vaccines is unequal
Despite their potential to reduce health outcomes gaps, there remain inequalities when it comes to accessing vaccines.
The COVID-19 vaccine rollout revealed these inequalities in access starkly: high-income countries vaccinated and protected their populations early, while LMICs faced delays and other challenges in accessing vaccines.
This led to vaccine wastage, greater disease and death, more restrictions and economic strain.
Even in non-pandemic situations, unequal access to vaccines persists. Newer vaccines are often more expensive than traditional childhood vaccines, reflecting higher research and development costs, and patent protections.
All of this means that vaccine uptake can be slower in LMICs – sometimes up to 20 years, with devastating consequences.
If we look beyond the COVID vaccine, recent research has shown that delays in the PCV rollout globally has cost many lives.
Health & Medicine
Immunising kids against pneumonia
Why do vaccine inequalities exist?
A combination of factors contribute to existing inequalities.
The hoarding of vaccines in high-income countries during the pandemic led to wastage and scarcity in other countries. The high costs of vaccine doses while countries deal with strained budgets mean that vaccines, even when available, are often unaffordable.
But there are other factors.
Countries have different budgets and purchasing power. Intellectual property protections and the multinational monopoly on vaccine production by companies based in richer countries means firms can push up the price.
This is especially problematic in middle-income countries (MICs) who lack support from organisations like Gavi, the vaccine alliance, and Pan American Health Organization (PAHO).
Our region has been the slowest in the world to adopt new vaccines. Small Island Developing Countries in the Pacific, despite access to pooled vaccine procurement through UNICEF, can end up paying even higher prices for vaccines than high income countries.
For countries transitioning away from Gavi support, a recent review found that Gavi’s gross national income-based eligibility model does not adequately reflect a country’s ability to pay. This suggests serious challenges with Gavi’s current eligibility criteria.
Rich countries and vaccine manufacturers benefit most
Our recent study, featured in the World Health Organization launch of a Special Issue in Vaccines, investigated the distribution of economic benefits of PCV across 194 countries and vaccine manufacturers.
And we found significant disparities between high and low-income countries.
Together, high income countries and manufacturers received the majority – around 76 per cent – of net economic benefits.
Specifically, net economic benefits gained per vaccinated child were highest in high income countries, which received six times, 12 times, and 24 times the PCV economic surplus of upper-middle, lower-middle and low-income countries respectively.
What needs to happen to address this inequality?
Our research, conducted in collaboration with Murdoch Children’s Research Institute and London School of Hygiene and Tropical Medicine, with funding from the NHMRC Centre for Research Excellence for Pneumococcal Disease Control in the Asia-Pacific and a Melbourne Research Scholarship outlines potential solutions to this inequity.
Health & Medicine
The vaccine saving the lives of Pacific children
A multifaceted approach requires global collaboration, better infrastructure and fairer pricing. It would help to ensure affordability and accessibility for all countries – leading to more equitable vaccine distribution and improved social welfare.
We need global partnerships to lower the intellectual property, technological and financial barriers in LMICs. This can allow for better technology transfer and knowledge sharing, and may help to enable local production to lower vaccine prices.
The unprecedented industry collaborations during COVID-19, like AstraZeneca with Serum Institute of India or Johnson & Johnson with Biological E, boosted vaccine access in LMICs.
If these partnerships were sustained, it could help close vaccine coverage gaps.
Pricing policy reform, including more steeply tiered pricing, restructuring of Gavi’s eligibility criteria, and innovative, inclusive pooled procurement mechanisms – especially for Small Island Developing Countries, can also reduce vaccine costs for LMICs and promote equitable access to vaccines.
Vaccine prices could be set based on the expected economic benefits they provide at a country level. Cross subsidisation can be strengthened by charging higher prices to wealthy countries to encourage them to ‘pay their share’.
In the meantime, large investments have been made in research into reduced dose schedules (that is, working out whether a lower number of doses of the vaccine would be as effective as current three doses), as this can also offer an opportunity to lessen the financial strain and ensure the sustainability of immunisation programs.
Australia’s role in health equity
In 2015, the charity, Médecins Sans Frontières (MSF), launched a call for action to PCV manufactures for fair PCV prices. In 2023 the World Society for Pediatric Infectious Diseases collected 500 signatories from 59 countries calling for fairer vaccine prices almost, which included nearly all the leading global child health and immunisation NGOs and professional societies.
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We need to do more to ensure Small Island Developing Countries and the poorest middle-income countries in our region have access to affordable vaccines. Development partners are also needed to provide support to introduce new vaccines.
In 2024, vaccine inequality remains a significant barrier to global health and this is likely to only get worse as more products reach licensure.
As Australia announces universal RSV vaccine for all Australian babies, we need to do more to prevent another 20 years passing by before children in poorer circumstances also get access.
The world can do more to ensure that, regardless of where they live, everyone has access to life-saving vaccines.
Australia is important in the vaccine development and access chain, and can play a key role in working towards global cooperation and investment towards health equity.
It’s time to our renew efforts towards reducing vaccine-related inequalities.